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General NPI Number Information
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NPI Number | 1487883831
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Entity Type | Individual
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Provider Name | GINNY L HENDRICKS M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 2850 W 95TH ST SUITE 101
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2735
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Country | US
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Telephone | 708-425-9550
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Fax | 708-229-6084
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Provider Business Mailing Address
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Address Line | 2850 W 95TH ST SUITE 101
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-2735
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Country | US
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Telephone | 708-425-9550
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Fax | 708-229-6084
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11015167A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036.129996
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License Number State | IL
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